Student Learning Guide for Myocardial Infarction
1. How much time does it take for the beginning of cellular necrosis in myocardial
infarction?
2. How long does it take for the entire thickness of the heart muscle to be necrosed?
3. Explain the five clinical manifestations of myocardial infarction.
Pain
Ashen, cold and clammy skin:
Blood pressure
Nausea and vomiting:
Increased Temperature:
4. Match the following ECG findings associated with myocardial infarction with their
implications.
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_____ ST segment elevation
A.
Necrosis
_____ T wave inversion
B.
Ischemia
_____ Pathologic Q wave
C.
Injury
5. How does the heart heal from an MI?
6.
Explain the seven complications of MI.
Dysrhythmias
Heart failure:
Cardiogenic shock
Papillary muscle dysfunction:
Ventricular aneurysm:
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Pericarditis:
Dressler syndrome
7. Which tends to be more extensive, a STEMI or an NSTEMI? How does this manifest
on the ECG tracing?
8. Fill out the following table on cardiac markers: (p. 781)
Marker
Time to peak
Time to return to
normal
Myoglobin
CK-MB
Troponin
9. What is the goal of percutaneous coronary intervention (PCI).
10. List four advantages to percutaneous coronary intervention (PCI).
11. What are the most serious complications of PCI?
12. What are the initial interventions in someone with severe chest pain?
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13. Describe the major nursing interventions post PCI. (Under cardiac catheterization on
Table 32-6)
14. What are the absolute and relative contraindications for fibrinolytic therapy in the
client with MI?
Absolute:
 Active internal bleeding (except menstruation)
 History of cerebral aneurysm, cerebral hemorrhage or AV malformation
 Intracranial neoplasm
 Recent ischemic stroke within 3 months
 Significant closed-head or facial trauma within 3 months
 Suspected aortic dissection
Relative:
 Active peptic ulcer disease
 Current use of anticoagulants
 Pregnancy
 Prior ischemic stroke greater than 3 months ago, dementia, or known
intracranial pathology not covered in absolute contraindications
 Surgery within 3 weeks or puncture of non-compressable vessel
 Internal bleeding within 2-4 wks
 Serious systemic disease
 Severe uncontrolled HTN (>180/110) on presentation, or chronic severe
poorly controlled HTN
 Traumatic or prolonged CPR (>10 min)
15. What is the goal of fibrinolytic therapy and within what time frame is it used?
16. What are the major post firbinolytic therapy complications?
17. What are the major indicators of reperfusion?
18. List three indications for coronary revascularization with CABG surgery.
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19. Complete the following table.
Drug
Nitroglycerin
Morphine
Use/Action in MI/ACS
Given for chest pain unrelieved by
nitroglycerin. Vasodilates 
decreases cardiac workload and
myocardial O2 consumption, reducing
contractility, & decreasing BP and HR.
Reduce anxiety & fear. Can depress
respirations (rare); monitor for signs
of bradypnea or hypoxia.
Beta blockers (Negative
Inotropic Drugs)
Atenolol (Tenormin)
Carvedilol (Coreg)
Propranolol (Inderal)
Stool softeners
Constipation due to bed rest &
opioids; stool softeners promote
comfort & prevent straining/valsalva
manuver ( Vagal stimulation 
bradycardia/dysrhythmias)
Ace Inhibitors:
Catopril (Capoten)
Enalapril (Vasotech)
Cholesterol-lowering drugs
Statins lower LDL and reduce
possibility of another MI
20. List manifestations of decreased cardiac output the nurse would assess following a
myocardial infarction.
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21. Identify priority nursing diagnoses, other than decreased cardiac output, for a client
with a myocardial infarction? Explain the rationale for your choices.
22. List interventions used to facilitate the following treatment goals for a client with a
myocardial infarction.
Pain control
 Assess pain (intensity, location, radiation, duration, precipitating &
relieving factors)
 Administer meds (nitro and/or morphine)
 12 lead ECG if pain increases suddenly to r/o extension of MI or
pericarditis
Decrease cardiac workload
Decrease anxiety
 Assess for verbal & nonverbal signs of anxiety
 Identify when level of anxiety changes (anxiety increases oxygen
demand)
 Use calm, reassuring approach
 Instruct in relaxation techniques
 Encourage verbalization of feelings, perceptions, fears
 Provide factual info concerning diagnosis, treatment, & prognosis
23. List six common emotional and behavioral responses to MI.
24. Identify nursing responsibilities when administering: See table 33-8 on pages 748749.
Medication category
Platelet inhibitors
Nursing Responsibilities
ASA should be administered as soon as ACS
suspected; watch for signs of bleeding; see
contrainds for fibrinolytic therapy
Narcotic analgesics
Beta blockers
Monitor pulse & BP regularly; use with caution in
clients with diabetes; nonselective agents may cause
bronchospasm, especially in clients with asthma
ACE inhibitors
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Thrombolytics
Anticoagulants
Assess for bleeding. Monitor PT, PTT, & INR. Review
Precautions with students.
Vasopressors
25. How will teaching needs change for a client with a myocardial infarction from the
acute to the convalescent stages of the illness?
26. How many METS should the client be able to expend at the time of discharge?
27. What types of exercise should be limited post-MI?
28. What should the client be taught regarding pulse rate and exercise? (p. 791)
29. What should the client be taught about sexual activity post-MI? (p. 792)
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Plan resumption that corresponds to activity before hospitalization
Physical training seems to improve physiologic response to sex; encourage daily
physical activity
Reduce eating/drinking ETOH before sex (wait 3-4 hrs after large meal)
Familiar surroundings & familiar partner reduce anxiety
Masturbation may reassure pt that sexual activity is still possible
Avoid hot or cold showers just before & just after sex
Foreplay allows gradual increase in heart rate before orgasm
Oral-genital sex places no undue strain on heart
Relaxed atmosphere free of fatigue & stress is best
Prophylactic nitrates effective in reducing angina during sex
Use of erectile agents contraindicated if taking nitrates
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
Anal stimulation can cause undue cardiac stress because of possibility of vasovagal response
30. What causes the majority of cases of Sudden Cardiac Death (SCD)?
31. List seven risk factors for SCD.
32. What is the most common approach to preventing a recurrence of SCD?
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